Messages about

Saw Palmetto

H ere are extracts of some messages concerning saw palmetto that I have found online in mailing lists and Usenet newsgroups:

Forum: sci.med.prostate.cancer
Subject: Alternative medicine at AUA
Date: 1999/07/03
Author: Norman Bauman < nbauman@escape.com >

I wrote a few stories for Urology Times about the complementary and
alternative medicine presentations at the American Urological Association
meeting, including Bill Fair's panel. Since you guys are so interested,
here's a summary of my stories. (The original abstracts should be available
on the AUA web site.)

The bottom line: There is good research to show that saw palmetto is
effective for relieving symptoms of BPH. PC-SPES has some unusual
estrogenic properties, which might be useful. But PC-SPES can also knock
your testosterone and PSA to zero. Doctors complain that their patients
take PC-SPES without telling them, and as a result they frequently miss a
diagnosis of prostate cancer, or of a prostate cancer turning
hormone-refractory. There also seem to be other drugs that have the same
effect as PC-SPES, and are mixed in with the
products that people buy in health food stores.

Any comments? Any questions? Has anybody here had problems of
mis-diagnosis because they were taking alternative medications?


PROMISES AND PITFALLS OF ALTERNATIVE MEDICINE


William Fair, MD, director of the prostate diagnostic center at Memorial
Sloan-Kettering Cancer Center, NY, took up the challenge to present
rigorous, high-quality research at a well-attended panel on complementary
and alternative medicine (CAM) in prostate disease at the American
Urological Association's 94th annual meeting here this May.

Fair explored complementary medicine after he developed colon cancer. He
discovered, "with surprise, how much science really exists." In
"allopathic" medicine, only "an estimated 15% of what we do is really
evidence-based." Much CAM "really should be a part of standard medicine,"
he said, citing diet, supplements, exercise, and stress reduction.

And now, with a panel organized by the AUA's new committee on CAM, Fair
made his best case:


Saw palmetto


-- Saw palmetto (Serenoa repens) improves symptoms of benign prostatic
hyperplasia, said Ian Thompson, MD, chief of urology, University of Texas,
San Antonio. In a meta-analysis of 18 randomized controlled trials
involving 2,939 men by Wilt (JAMA 280:1604-9), both magnitude of
improvement and confidence interval "all tend to favor the efficacy of saw
palmetto," similar to finasteride with less erectile dysfunction.

The 26-week Permixon vs. finasteride trial (Prostate 29:231-40), involved
1,098 men. Finasteride lowers by 50% the level of prostate specific antigen
(PSA), routinely used to screen for prostate cancer and monitor prostate
cancer therapy. Finasteride does not affect prostate cancer, but PSA values
must be doubled. Unexpectedly, saw palmetto had "absolutely no impact
whatsoever" on PSA, noted Thompson.

Even Stephen Barrett, MD, who runs the Quackwatch web site
< http://www.quackwatch.com >, said saw palmetto is on top of his "short
list" of products worth studying.

-- Vitamin E, selenium, and other antioxidants seem to reduce prostate
cancer incidence, said Neil Fleshner, MD, MPH, assistant professor of
surgery, University of Toronto. The Alpha-Tocopherol, Beta-Carotene (ATBC)
Cancer Prevention Study (J Natl Cancer Inst 90:440-6) randomized 29,133 men
to alpha-tocopherol (vitamin E), beta-carotene, or placebo. At 4 years, men
on vitamin E had 41% less prostate cancer mortality. This is supported by
animal, in vitro, and human studies.

"These are quite powerful data," said Fleshner, "because they are
randomized." However, ATBC was a lung cancer trial, with prostate cancer a
secondary endpoint. The proposed NIH 32,400-patient, 10-year SELECT trial
would have prostate cancer as primary endpoints.

-- PC-SPES inhibits hormone-resistant prostate cancer cells, in animal and
human studies, said Fair. PC-SPES is an 8-herb mixture from traditional
Chinese medicine. Prostate cancer normally requires testosterone to grow.
Inoperable prostate cancer is treated with anti-testosterone hormones.
Eventually, prostate cancer resists this hormone treatment, with poor
prospects. But PC-SPES lowers testosterone (and PSA) dramatically.

A Phase II study of PC-SPES by Eric Small, MD, UCSF, reported in May to the
American Society of Clinical Oncologists, found more than 50% PSA decline
in 19/34 (58%) hormone-resistant patients, and other indications of cancer
regression, noted Fair. A German study had similar results.


Undiagnosed cancer


But CAM harms patients, too. Without telling their doctors, they take
compounds that lower PSA, make prostate cancer undetectable, and confound
hormone therapy. 46% of the American public uses alternative medicine, but
less than 40% of them tell their doctors about it (JAMA 280:1569-75).

Robert Gibbons, MD, Virginia Mason Medical Center, Seattle, WA, was the
panel's skeptic. We don't know the mechanism, or the composition, of CAM
products, he said. Patients ask, "Are these things safe?" and he answers,
"We simply don't know."

Gibbons had one patient, with borderline PSA and positive biopsy for
prostate cancer, who chose watchful waiting. Over a year, his PSA, and
prostate size, declined--but his cancer progressed, undetected. "A friend"
had given him "a compound," with 15 ingredients.

Mark Moyad, MPH, on the AUA's committee, saw 2 patients at the University
of Michigan whose prostate cancer became hormone-resistant, but it was
undetected, because they were taking PC-SPES and their PSA remained low.

Urologist Arnaldo Trabucco, MD, North Shore Hospital, Manhasset, NY, saw
"about a dozen" patients this past year whose prostate cancer was
undetected in PSA tests because of herbal products--which they were usually
taking to prevent prostate cancer, because of family history.

Mailing List: Prostate
From: Rick Ward
Date: Fri, 21 Nov 1997 11:20:19 -0500

In the hope that it will help in this discussion, here is most of what I posted on SeedPods on this subject.

Rick Ward in Deer Lodge, MT

Date: Mon, 30 Jun 1997 00:13:58 -0400 (EDT)
Subject: [SeedPods] Saw Palmetto

This topic comes around with regularity and rarely without very definite positions being taken. And that's among us chickens! Try the docs—nearly to a man (or woman, as the case might be) they denigrate it as hillbilly medicine. So, I've done a little looking at the literature on Saw Palmetto, or Serenoa repens as it is known in the scientific world (the name you should use when searching for it in medical annals). BTW, in Europe it is generally used as a lipidosterolic extract of serenoa repens (LSESR) or Permixon.

First, in order to follow the literature on Saw Palmetto, or Serenoa repens (SR), we have to understand a little of what is going on in the prostate foodchain.

While there is some direct uptake of testosterone (T) by the prostate tissues (benign or malignant), it is dihydrotestosterone (DHT) that is the "food of choice" for prostate tissues. DHT is an androgen of T metabolized from T and some precursors produced by the adrenals, e.g., DHEA, that currently popular "fountain of youth hormone" being marketed everywhere today. One more player enters here, 5 Alpha-reductase (5Ar), an enzyme that is essential to the metabolic process of T to DHT.

When we seek to interdict the prostate foodchain, we do whatever is necessary to keep DHT (and T) from the prostate cells. We are all familiar with the LHRH agonists (Lupron, Zoladex) that shut down the production of T in the testes, reducing serum T to 95% of the pre-intervention levels, and DHT in the gland to 45% of pre-intervention levels. And we are familiar with the androgen blockers (Eulexin, Casodex) to take care of that remaining DHT from whatever source: adrenal T and/or adrenal precursors. And we've been made aware of the role Proscar (finasteride) can play in the interdiction as a 5Ar inhibitor.

It is in this last area that SR operates, as not only an inhibitor of 5Ar but as a blocker of 5Ar similarly to the way the androgen blockers keep DHT from being used by the prostate cells. That is the claim, and the subject of scientific studies of SR. These studies are mainly European, and therein lies the rub. Our homegrown docs seem not to regard research conducted outside the US as valid. At least I've found that to all too often be the case with such as SR and CHB (they acknowledge the LHRH efficacy, saying basically that only 5% serum T is acceptable; they do not believe the 45% residual DHT found by Labrie, usually).

As early as 1993 SR was investigated for its prostate gland debulking capability in a "multicenter double blind study of BPH treated with the association CPA [Cyproterone acetate] plus Serenoa Repens. A statistically significant difference in prostate volume reductions between the groups treated with the combinations and those with the monotherapies was observed."

-- Pharmacological combinations in the treatment of begnin prostatic hypertrophy
Di-Silverio-F, et al; J-Urol-Paris. 1993; 99(6): 316-20.

[The other combination referred to in this paper was CPA + TAM (Tamoxifen), in a study done in 1985.]

Suggestions were made at that time that more combinations should be investigated, particularly those that were alpha and androgen blockers, suggesting that the efficacy of such combination treatments might be associated with "the long term results of a 5 alpha reductase inhibitor, antiestrogen or aromatase inhibitor."

In 1994 a study was conducted "(1) to identify the 5 alpha reductase (5 alpha-R) isozyme(s) present in DU 145 cells, a human cell-line of low androgen sensitivity . . . and (2) to compare the inhibitory potencies of three compounds on the 'basic' 5 alpha-R isozyme expressed in baculovirus- directed insect cell system." The study clarified that the DU 145 PCa cell line only has type 1 5AR expressed, type 2 being more active in the androgen sensitive cell line, LNCaP. Even though the study noted that finasteride (Proscar) is not strong against type 1 5AR, and SR would require a dose 3x the finasteride dose to similarly inhibit 5-AR production, it suggested that 'LSESr might exert a regulatory inhibitory activity due to its specific lipid/sterol composition."

-- Inhibition of the activity of 'basic' 5 alpha-reductase (type 1) detected in DU 145 cells and expressed in insect cells
Delos-S, et al; J-Steroid-Biochem-Mol-Biol. 1994 May; 48(4): 347-52.

That lipid connection was explored in a 1995 study that ended with an ambivalent picture of the lipid contribution: "These observations suggest that the lipid component of LSESr might be responsible for its inhibitory effect by modulating the membrane environment of 5 alpha-reductase. Partially purified recombinant 5 alpha-reductase type 1 activity was preserved by the presence of lipids indicating that lipids exert either stimulatory or inhibitory effects on human 5 alpha-reductase."

-- Human prostatic steroid 5 alpha-reductase isoforms—a comparative study of selective inhibitors
Iehlea-C, et al; J-Steriod-Biochem-Mol-Biol. 1995 Sep; 54(5-6): 273-9.

Now isn't that just like everything in PCa? They can either stimulate or inhibit . . . your PCa can be either slow or fast growing . . . flax oil is either the greatest thing since crackerjacks or pure poison for PCa folks.

But then another 1995 study, while not addressing the quantitive relativity between them, explored the efficacy of the three inhibitors, 4-MA, finasteride, and Serenoa repens, with SR surprisingly a strong finisher. They found that 4-MA was most effective in inhibiting DHT in the epithelial cells (BPH) and finasteride in the fibroblasts (adenocarcinoma—our ol' friend, PCa). But they found ". . . the lipido-sterol extract of Serenoa Repens (LSESr, Permixon) inhibited the formation of all the T metabolites studied . . . in epithelial cells and fibroblasts [BPH and adenocarcinoma] . . . ." They conclude, "These results have important therapeutic implications when selecting appropriate treatment options for BPH."

-- Testosterone metabolism in primary cultures of human prostate epithelial cells and fibroblasts
Delos-S, et al; J-Steroid-Biochem-Mol-Biol. 1995 Dec; 55(3-4): 375-83.

Or for treating PCa, it would seem.

A 1996 study used 3 groups of rats to study the effect of LSESR (Permixon) on gland growth or debulking:

Group 1 Castrated rats treated with estradiol and testosterone
Group 2 Castrated rats treated with estradiol and testosterone and LSESR
Group 3 "sham rats" treated only with LSESR

Rapid gland bulking was observed in Group 1, peaking at 30 days. But those treated with LSESR (Groups 2 and 3) had the prostate weight from the hormone treatment "inhibited by administration of LSESR. Indeed, the weight was significantly lower at day 60 and day 90 for the dorsal and latgeral regions of the prostate. The weight of the ventral region of the prostate was significantly lower after 30 and 60 days treatment with LSESR."

Remember, these studies from Europe are reporting on substances and uses *common* in medical intervention in BPH. Thus, the study concludes, "These results demonstrate that administration of LSESR to hormone-treated castrated rats inhibits the increase in prostate wet weight. This effect of LSESR may explain the beneficial effect of this extract in human benign prostatic hypertrophy."

-- Effect of Serenoa Repens extract (Permixon) onestradiol/testosterone- induced experimental prostate enlargement in the rat
Bazan-NG, et al; Pharmacol-Res. 1996 Sep-Oct; 34(3-4): 171-9.

And finally, we have a concluding study, the abstract of which I will offer in toto:

-- Serenoa repens (Permixon). A review of its pharmacology and therapeutic efficacy in benign prostatic hyperplasia
Plosker-GL; Brogden-RN
Drugs-Aging. 1996 Nov; 9(5): 379-95.

ABSTRACT
Serenoa repens (Permixon) has been available for several years for the treatment of men with benign prostatic hyperplasia (BPH). The drug is the n-hexane lipidosterolic extract of the dwarf American palm (also known as Serenoa repens) and is a complex mixture of various compounds. A number of pharmacodynamic effects have been demonstrated with the lipidosterolic extract of Serenoa repens (LSESR), suggesting multiple mechanisms of action including in vitro inhibition of both type 1 and type 2 isoenzymes of 5 alpha-reductase and interference with binding of dihydrotestosterone to cystolic androgen receptors in prostate cells. In controlled clinical trials in men with BPH, oral administration of Serenoa repens 160 mg twice daily for 1 to 3 months was generally superior to placebo in improving subjective symptoms, such as dysuria, as well as objective parameters. The frequency of nocturia was reduced by 33 to 74%, while urinary frequency during the day decreased by 11 to 43% and peak urinary flow rate increased by 26 to 50% with Serenoa repens. Corresponding values for placebo were 13 to 39%, 1 to 29% and 2 to 35%. The only large comparative trial conducted to date, in which >1000 men with moderate BPH were randomized to receive Serenoa repens 160 mg twice daily or finasteride 5 mg once daily for 6 months, demonstrated similar efficacy between the two drugs. No statistically significant difference was demonstrated between treatment groups for improvement in patient self-rated quality-of-life scores and the primary end-point of objective symptom score; International Prostate Symptom Score improved by 37% with Serenoa repens compared with 39% with finasteride. In much smaller comparative trials, few significant differences were demonstrated between Serenoa repens and alpha 1-receptor antagonists, and larger randomised trials of adequate duration are required to better compare the clinical efficacy of these drugs. The most frequently reported adverse events in clinical trials with Serenoa repens have been minor gastrointestinal problems (e.g. nausea and abdominal pain). In conclusion, Serenoa repens is well tolerated and has greater efficacy than placebo and similar efficacy to finasteride in improving symptoms in men with BPH. Although there is a need for further comparative studies, particularly with alpha 2-receptor antagonists, available data indicate that Serenoa repens is a useful alternative to alpha 1-receptor antagonists and finasteride in the treatment of men with BPH.
================

Now, IMO, taken along with the effectiveness in 5-AR inhibition in *both* epithelial cells (BPH) and fibroblasts (PCa), the "inhibition of both type 1 and type 2 isoenzymes of 5 alpha-reductase and interference with binding of dihydrotestosterone to cystolic androgen receptors in prostate cells," and being "well tolerated . . . and similar efficacy to finasteride," makes me willing to take the intuitive leap and extrapolate a positive effect in PCa treatment.

Just as bombing the smallest bridge on a rail line to the battlefield interdicts enemy supplies and wiping out the source of the supplies does so as well, anything that inhibits and/or blocks the use of a critical element (5-AR) in the production of DHT is an important adjunctive treatment option.

IMO. It passes my Chicken-Soup-Test: can't hoit, and it may help. Besides, it's *cheap*, particularly when compared to finasteride, Proscar.

But you must remember, I'm prejudiced. In 58 days of CHB (Eulexin+Lupron) along with 26 fractions (160 rads ea) of EBRT, my 31.4 cc gland was debulked to 15.4 cc; I had been taking Saw Palmetto, SR, for 15 months by then. The doc was only looking for a 40-45% reduction, not more than 50%. Who knows? Chicken soup?

Newsgroup: sci.med.prostate.bph
From: ntrobin@clonis.net (Nathan)
Date: 9/25/96 5:23 PM

Every single study I have seen when comparing Saw Palmetto with Proscar has not only shown that Saw Palmetto works as well as Proscar on BPH (and without the toxicity of Proscar I might add), but actually is superior. Do a search on Medline using Serenoa Repens. What you'll find are a few studies done comparing Saw Palmetto with Finasteride (Proscar).

The study you sight comparing Permixon with Proscar is there. However, what that study actually said was that yes Proscar does indeed lower DHT levels and Saw Palmetto does not significantly lower DHT levels. However, this is simply because Saw Palmetto doesn't work that way. What it does is prevent DHT from BINDING to receptors, thus neutralizing it's effect. As to it's effect on hairloss, if I'm not mistaken BOTH cut down DHT levels in scalp tissue. However, they only do this partially because of the two types of 5-alpha reductase that are involved (both working only partially on the type causing MPB). And then there is the immune aspect coming into play as well, which is believed to be the main culprit in the destruction of the follicle.

Mailing List: Prostatitis
From: "Robert A. Fink, M. D." <rafink@IBM.NET>
Date: Fri, 20 Sep 1996 19:03:53 GMT

I have been taking Saw Palmetto and Zinc (from a health food store) for about 5 months and have noted a difference. I even note a difference (worsening of symptoms) if I occasionally miss a day's dose or two. This could, of course, be the "natural course" of the disease, but, at this point, I am happy to take the medicine. My experience is not "scientific", but, for now, it positive.

Robert A. Fink, M. D., FACS Professional Corporation
Diplomate, American Board of Neurological Surgery
2500 Milvia Street Suite 222
Berkeley, California 94704-2636 USA
Phone: 510-849-2555
FAX: 510-849-2557

Mailing List: Prostate
From: Merrill Cobb <merrilc@INFOHWY.COM>
Date: Mon, 9 Sep 1996 14:54:14 -0500

I took saw p. from June '94 until Nov '95. It seemed to help urination frequency and intensity of need to go. Quit unil Mar '96. Boy, was that a mistake. was up most nights at least once. frequently had to go almost hourly during the day. flow slowed to a weak "spray" so uncontrolled that I had to sit. Resumed regular usage in April '96 and have noted slow steady improvement. I have not been up at night for several weeks. Flow is still slow but I can now use a urinal if I stand close enough and could probably use a commode if i could see over this fat belly. It is sure helping the BPH symptoms but I am skeptical that it has any effect on cancer (if it is present).

During the first usage, I used a product from BIOTICS a Houston, TX company which makes a varity of potions favored by the natural and organic only crowd. Since April I have been using the stuff sold by GNC. It is cheap and seems to work.

I saw a post (somewhere but not here) several months ago by a pharmysicist who said that the only useful extract was from the berry oil and that most in the U.S.A. was from the water of the berry and therefore useless.

Merrill Cobb
Houston, TX

Mailing List: Prostate
From: Ralph Valle <ralphv@NETZONE.COM>
Date: Sun, 25 Aug 1996 10:18:21 -0700

At 09:47 PM 8/25/96 +0700, george orick wrote:
>Neophyte's confusion:
>
>The 4-part dissertation on saw palmetto (Permixon and Serenx) posted Friday
>23 August by DeWitt Ober swayed me heavily in my search for relief from
>urinary troubles, perhaps numbing normal skepticism.
>
>Your several queries today (25 August) obviously reflect your requirement
>for specific studies. Do they also reflect skepticism and substantial doubt?

Hi George,

There is a study of Proscar vs Saw Palmetto and its effects on DHT. Proscar was effective and Saw Palmetto did not affect the level of DHT That in itself is indicative that if SP works, the mechanism is different from that of Proscar. There are other studies in vitro, that contradict the above study, but nothing really substantial that would indicate that SP is a cancer preventive material. Most studies are related to BPH and in that respect it seems that SP helps improve the condition (BPH).

Sources:
Adriazola Semino M. Lozano Ortega JL. Garcia Cobo E. Tejeda Banez E. Romero Rodriguez F. [Symptomatic treatment of benign hypertrophy of the prostate. Comparative study of prazosin and serenoa repens]. [Spanish] Arch Esp Urol. 45(3):211-3, 1992 Apr.

Strauch G. Perles P. Vergult G. Gabriel M. Gibelin B. Cummings S. Malbecq W. Malice MP. Comparison of finasteride (Proscar) and Serenoa repens (Permixon) in the inhibition of 5-alpha reductase in healthy male volunteers. European Urology. 26(3):247-52, 1994.

>What I'm asking is: is saw palmetto worth a serious prolonged try when I
>return to France in two weeks, or is it likely to turn out to be a harmless
>elixir of little benefit? Like chicken soup: it won't hurt and it might help?

I would try it for a few weeks and see if it helps. Who says that chicken soup doesn't work?

Mailing List: Prostate
From: Stephen Strum MD <73140.3041@COMPUSERVE.COM>
Date: Sun, 25 Aug 1996 00:43:51 EDT

DeWitt:

>PERMIXON has two documented mechanisms of action: 1) It blocks the enzyme 5
>alpha reductase, thereby inhibiting the serum conversion oftestosterone to
>dihydrotestosterone.
>2) It blocks receptor sites on cell membranes required for
>prostate cells to absorb DHT and testosterone.
>SNIP
>Reducing serum DHT levels and displacing DHT and testosterone from prostate cells

I find no documentation for reference 1 being true. 2 studies refute any effect on 5 alpha reductase. Can you site references and also refs for item 2? Saw palmetto has not been shown to have an effect like anti-androgens that block the androgen receptor. I do not know its mechanism of action but would appreciate any refernences that would clarify this.

>Since PROSCAR does not block DHT's binding to receptor
>cites on prostate cells, its only function is to inhibit
>DHT formation in the blood, whereas PERMIXON both inhibits
>DHT production and blocks DHT binding to prostate cells.

DHT formation, when it is blocked, is not done in the blood but within the prostate cell or where there is 5 alpha reductase. Please support these statements with reference material. Otherwise your efforts are being misdirected.

Please see our homepage re: study we suggested comparing Proscar vs Saw Palmetto. This is appropos in regards to your comments

>Clinical trials haveshown that PROSCAR only works in 37% of cases
>after taking the drug for a full year compared to 60%-to-90% success after
>only six weeks with saw palmetto extract. About 5% of men on PROSCAR
>suffer from decreased libido, ejaculation disorders, and impotence compared
>to zero side effects for saw palmetto extract.

There is supposed to be a study that compares Proscar with Saw Palmetto. Anyone with a reference to that please cite it. Most existing studies compare saw palmetto with placebo OR compare Proscar with Placebo.

>A new study published this year in the Journal of Steroid
>Biochemical Molecular Biology shows that saw palmetto
>extract is three times more effective against certain
>prostate cancer cell lines than PROSCAR. The researchers
>state that the lipid/sterol composition of standardized saw
>palmetto extract shows a specific inhibitory effect against
>metastasized prostate carcinoma. While this study is
>preliminary, it is one more piece of evidence that this
>natural herbal extract - with hundreds of years of human
>use - is superior to an expensive FDA-approved drug that
>was not available to Americans until 1989.

Please share the exact reference for this paper. This is potentially important. Please be aware that there are papers also on Proscar showing anti-cancer effect against PC, even androgen independent PC.

Good post DeWitt.

steve

Mailing List: Prostate
From: Stephen Strum MD <73140.3041@COMPUSERVE.COM>
Date: Sun, 25 Aug 1996 00:43:46 EDT

Dewitt wrote:

>and while this reduces the size of the prostate, it does so
>without compromising testosterone levels in the blood.
>Indeed, lab studies of prostate tissue from rats fed saw
>palmetto reveal that while their testosterone levels are
>the same as rats that didn't receive the herb, their level
>of DHT are lower.

So far we have not had one patient where the DHT level dropped after serenoa repens.

steve

Mailing List: Prostate
From: Stephen Strum MD <73140.3041@COMPUSERVE.COM> Date: Sun, 25 Aug 1996 00:43:48 EDT

Dewitt wrote:

>Saw palmetto seems literally designed to tackle this mess
>because what it does is:
>1. Deactivate the enzyme (5 alpha reductase)
>2. Prevent DHT from acting on prostate cells, and
>3. Serve as a mild anti-inflammatory on the troubled prostate gland.
>The basic mechanism here turns out to be the same as in
>the prescription drug finasteride...

Number 1 and 2 are not supported by any studies. Finasteride or Proscar involves mechanism 1, not 2. I don't know of any data that resolves the # 3 item.

steve

Mailing List: Prostate
From: DeWitt Ober <dober@WORLDNET.ATT.NET>
Date: Fri, 23 Aug 1996 21:12:36 +0000

Dr Strum writes:

>No real evidence that saw palmetto affects serum DHT per two studies in the
>literature. No evidence that saw palmetto has a role in PC. No evidence
>means no evidence showing effect or no effect: no studies done at all.

Lets talk about it...
Some of the following info I've had for over a year and may be outdated, however, I would like to see a discussion on the subject for the benefit of all. (I've never used it).

Part I

From: Prevention, Aug. 95
...........if common BPH is found, there is surgery, the relatively new drug finasteride, or in less serious cases, learning to live with it.

But there is another alternative these days - an herbal formulation made from a plant called saw palmetto. Growing wild in the American southeast, and long used as a folk remedy here, its now cultivated and the berries shipped to Europe.

There, the berries are processed by pharmaceutical firms into a standardized product with guaranteed potency. European men take it in droves. Many doctors there prescribe it. The German Commission E, which evaluates natural therapeutic agents, has given its blessing to saw palmetto. The United States has nothing comparable to Germanys Commission E. As far as our Food and Drug Administration is concerned, the lack of American research with the herb makes it ineligible for any kind of approval.

In Europe, though, there's been lots of research, much of it carried out in a very careful manner.

One of the earliest studies, by a French group, looked at the effect of saw-palmetto extract on 94 men with the usual BPH symptoms. Actually, only half got the herb; the others received a look-alike placebo to rule out the power of suggestion.

After a month, the doctors interviewed and evaluated the men, without being aware of what group they were in - the herb or placebo. What they found was that the herb takers reduced the number of times they had to get up at night by nearly half, increased their flow rate by the same amount, and lessened residual urine by 42 percent. The placebo group fared much worse; their residue, for instance, actually increased by 9 percent (British Journal of Clinical Pharmacology, volume 18, 1984)

An Italian study published in Urologia in 1988 found much the same. With saw palmetto (which they refer to by its Latin name, Serenoa repens), nighttime bathroom visits decreased from an average of just over 4 per night to about 1.5 after three months. The placebo group saw no improvement.

Prevention herbal advisor, Varro Tyler, Ph.D., reports that good studies on 2,000 BPH patients in Germany confirm the effectiveness of saw palmetto extract.

If you're wondering how a berry can be so good for the prostate, scientists have a pretty good idea of how it works.

What triggers prostate growth is a ..... form of the male hormone testosterone. It's called DHT (for dihydrotestosterone), and when it gets to an older mans prostate cells, it makes them think they're going through puberty again, and the gland begins packing on the beef.

As for where this troublemaker comes from - well, from an instigator enzyme called 5 alpha reductase, which causes normal testosterone to switch into the hopped-up DHT.

Saw palmetto seems literally designed to tackle this mess because what it does is:

1. Deactivate the enzyme (5 alpha reductase)

2. Prevent DHT from acting on prostate cells, and

3. Serve as a mild anti-inflammatory on the troubled prostate gland.

The basic mechanism here turns out to be the same as in the prescription drug finasteride. ....................Side effects? Reports we've seen say they are rare and nonspecific. Still, if and when you use herbs of any kind, be cautious and watch for unexpected reactions.

Can you make a tea from saw palmetto? No, it won't do anything for your prostate because the active ingredients are not soluble in water. All the research weve seen was done with standardized extracts made in Europe (now sold here, too), with a daily dose of 320 milligrams a day (two 80 mg. capsules, twice daily).

Keep in mind that saw palmetto is not approved by the FDA for any use in the United States. Anyone taking it should check with his physician.

Part II

SAW PALMETTO EXTRACT VS. PROSCAR

For many years, The Foundation has recommended the European drug PERMIXON as an effective therapy for benign prostatichypertrophy.

PERMIXON is a standardized extract from the saw palmetto berry, also known as serenoa repens. PERMIXON was used in Europe for almost 20 years before the FDA approved an expensive, less effective drug (PROSCAR) that causes undesireable side effects in some men. PERMIXON has two documented mechanisms of action:

1) It blocks the enzyme 5 alpha reductase, thereby inhibiting the serum conversion of testosterone to dihydrotestosterone.

2) It blocks receptor sites on cell membranes required for prostate cells to absorb DHT and testosterone.

Reducing serum DHT levels and displacing DHT and testosterone from prostate cells, inhibits the hyper-proliferation of prostate cells, which results in a reduction in prostate volume and, in most cases, relief from the symptoms of prostate enlargement.

Since PROSCAR does not block DHT's binding to receptor cites on prostate cells, its only function is to inhibit DHT formation in the blood, whereas PERMIXON both inhibits DHT production and blocks DHT binding to prostate cells. Clinical trials have shown that PROSCAR only works in 37% of cases after taking the drug for a full year compared to 60%-to-90% success after only six weeks with saw palmetto extract.

About 5% of men on PROSCAR suffer from decreased libido, ejaculation disorders, and impotence compared to zero side effects for saw palmetto extract.

Although PROSCAR has received much media attention, only a minority of patients benefit from the drug after taking it for a year. Clearly, saw palmetto extract is superior to PROSCAR. Saw palmetto extract is also significantly less expensive - only one-fifth the price of PROSCAR!

The results of 32 published studies have shown that the standardized extract of the saw palmetto fruit produces a significant improvement in men with prostate enlargement resulting in the following clinical observations:

Reduction of nocturnal urinary urgency
Increased urinary flow rate
Reduced residual volume in the bladder.
Reduction in uncomfortable urination symptoms.

PERMIXON costs about $45.00 a month in Europe. PROSCAR costs about $60.00 a month in the United States. You will soon read about a new PERMIXON generic formula that costs just $12.00 a month.

NEW STUDIES ON SAW PALMETTO
A paper just published in the journal Current Therapies, Research, Clinical Experience (USA) reports on a Belgian study involving 505 men with benign prostate disease. The results showed that saw palmetto extract produced an improvement in urinary flow, residual urinary volume, prostate size, the quality of life score and the International Prostate Symptom Score after only 45 days of treatment.

After 90 days, 88% of the patients and treating physicians considered the treatment effective. In addition, the study showed for the first time that saw palmetto extract does not mask the PSA score as PROSCAR has been shown to do. The researchers concluded by stating, "The extract of the serenoa repens appears to be an effective and well-tolerated pharmacologic agent in treating mictional problems accompanying benign prostatic hypertrophy."

The National Cancer Institute is sponsoring an 18,000-man study to determine if the DHT blocking effects of PROSCAR will reduce the incidence of prostate cancer. Half the men will be given PROSCAR, the other half placebo. The rate at which those given placebo develop prostate cancer will be measured against those receiving PROSCAR.

Since DHT is strongly suspected as playing a role in the development of prostate cancer, the expectation is that PROSCAR will reduce the incidence of prostate cancer. Saw palmetto may be superior to PROSCAR in protecting against prostate cancer. A new study published this year in the Journal of Steroid Biochemical Molecular Biology shows that saw palmetto extract is three times more effective against certain prostate cancer cell lines than PROSCAR. The researchers state that the lipid/sterol composition of standardized saw palmetto extract shows a specific inhibitory effect against metastasized prostate carcinoma. While this study is preliminary, it is one more piece of evidence that this natural herbal extract - with hundreds of years of human use - is superior to an expensive FDA-approved drug that was not available to Americans until 1989.

NATURAL, LOW-COST ALTERNATIVES TO FDA DRUGS
The FDA denied Americans access to DHT-blocking therapies until 1989. When PROSCAR was finally approved, it cost $60.00 a month, and men are supposed to take it forever.

Initially, The Life Extension Foundation saved its members from painful, side-effect-prone, expensive, temporary surgical procedures by recommending European companies that ship PERMIXON to Americans.

The Foundation then found low-cost generic products containing the identical herbal extract used in PERMIXON. When the herb pygeum was found to work well against prostate enlargement in Europe, the Foundation found a company offering a combination of saw palmetto and pygeum.

There is now a new low cost, highly absorbable product that contains the identical dose of standardized saw palmetto extract as PERMIXON in an olive oil base, rich in essential fatty acids, which may possess an anti-inflammatory effect to further reduce prostate volume. The cost of a one month supply of SERENX is just $12.00 through the non-profit Life Extension Buyers' Club!

If you are using our Saw Palmetto Extract ($14) or our Saw Palmetto/Pygeum Extract ($20.75 a month), you should consider substituting this new highly absorbable standardized saw palmetto extract that costs just $12.00 a month. While most men have received tremendous benefits from the Saw Palmetto/Pygeum combination, those who only received partial benefit may want to try a three-month supply of SERENX. The most recent research (1994) shows that 88% of men benefitted significantly from this standardized extract after only three months.

If you're a man over 35, you should consider preventing prostate disease by taking two SERENX capsules a day. The cost is just $12.00 a month. If you cannot afford this, take just one capsule a day ($6.00 a month). The benign enlargement of the prostate gland is the most inevitable disease men face, and this is an affordable way to prevent benign and, possibly even malignant, prostate disease. The side benefits to this therapy could be ation in age-related hair loss, improvement of acne, and a reduction of facial hair (in both men and women).

To order SERENX, or the SAW PALMETTO/PYGEUM combination, call the Life Extension Buyers' Club at 1-800-841-5433.

Part III

From.....Men's Confidential, Sep 95

"SAW SALVATION"

A centuries-old herbal remedy may be more effective at shrinking enlarged prostates than the best new drugs......

....These days you can't pick up a magazine or watch a late- night TV show without being bombarded with images of men kept up at night by the symptons of their enlarged prostates: urinary urgency and frequency. Equally in- escapable are the claims of major American pharmaceutical companies that drugs like Hytrin, Proscar and Cardura can turn back the clock on enlarged prostate, or benign prostatic hyperplasia (BPH).

Trouble is, for many men with mild symptoms, such drugs can cause more problems than they solve, replacing pesky urinary symptoms with things like impotence, dizziness, low libido and breast enlargement. New research suggests that there may be a way out of this overkill: a kinder, gentler, herbal alternative that's as close as your neighborhood drugstore.

The herb in question is the saw palmetto berry, also called "Serenoa repens". Native to the United States, it was first used hundreds of years ago by the Seminole Indians, who considered it a potent aphrodisiac. Over the past two decades, however, it has gained wide acceptance as a prostate treatment throughout Europe. In fact, most recent available figures indicate that saw palmetto accounts for 38 percent of all medications prescribed for BPH in Italy alone. That's a bigger chunk of the market than any syn- thetic BPH drug can claim.

And the herb's Continental popularity is not just a matter of folk wisdom. Just ask Jim Duke, Ph.D., former economic botanist for the USDA and author of the CRC Handbook of Medicinal Herbs. "I'd bet my prostate on the fact that this stuff works," notes Duke, who has devoted the last 55 years to the study of edible plants and medicinal herbs. "Not only are there men in Europe and America who swear by it, I can count a good number of scientific studies done over the last decade that indicate saw palmetto can help relieve symptoms in men with BPH."

The latest news on saw palmetto may turn out to be the most convincing. At this summer's World Health Organiza- tion's Third International Consultation on BPH, held in Monaco, the buzz was that saw palmetto may be every bit as good for BPH as the prescription drug finasteride (Proscar). Researchers in nine European countries have spent the last year comparing the treatments in a large controlled study. Because the full results of their work won't be completed for several more months, the doctors involved won't tip their hands to talk much about it. But they will say their early data, which they handed over to a panel of experts at the Consultation are very strong. "Our findings to date show that saw palmetto equals finasteride in relieving symptoms of BPH," one French researcher told us.

But that's just the latest tip of the saw palmetto iceberg. A British study of 110 men with BPH showed that saw palmetto extract significantly increased urine flow, decreased the amount of urine left in the bladder after urinating, and reduced nighttime trips to the bathroom. And a study conducted in Italy on 40 BPH patients showed similar improvements in symptoms among men taking the herb, as compared with men taking a blank pill.

Just how does it work? The herb may prevent the breakdown of testosterone into "dihydrotestosterone" (DHT), a more potent form of the hormone that researchers believe may trigger prostate enlargement, according to research done by Franco diSilverio, M.D., a urologist at the University Bracci in Rome, Italy....

And while this reduces the size of the prostate, it does so without compromising testosterone levels in the blood. Indeed, lab studies of prostate tissue from rats fed saw palmetto reveal that while their testosterone levels are the same as rats that didn't receive the herb, their level of DHT are lower.

With all the evidence that saw palmetto offers a safe, effective and low-cost option for men with BPH symptoms, we had to ask: What's the real reason the American medical machine has ignored it for so long?

The key, says Duke, is money. The testing necessary to get FDA approval for most drugs costs upwards of $200 million. Small herbal companies simply don't have that kind of money. And large drug companies aren't going to spend money on something that may compete with their top products and, in the case of herbs, can't be patented. "So we're stuck in a system where we pay two to three times more for 'approved' drugs, and our doctors won't recommend an herb that's working for men all over Europe," explains Duke. "We grow it here and ship it to the Europeans so they can get the benefits. It makes absolutely no sense."

Another point that makes no sense to many experts is the fact that despite saw palmetto's lack of side effects, the FDA outlawed its sale as an over-the-counter prostate treatment in 1990, the same year that the agency approved the prescription drug finasteride. Notes Andrew Weil, M.D., professor of medicine at the University of Arizona College of Medicine and author of Natural Health, Natural Medicine and Spontaneous Healing, "It's hard to avoid the suspicion that their decision could have been influenced by the emergence of a new prescription drug."

Saw palmetto can still be sold legally in the U.S. as a food supplement, although that designation also means, since it's not a drug, it can't be prescribed by a doctor. But that doesn't stop physicians like Dr. Weil from recom- mending it to their patients. "Patients will come to me with BPH symptoms and say, 'I'm not ready for hard-core drug therapy.' They're looking for a natural alternative. Saw palmetto is ideal for them, because it's so low risk. There are no side effects, and if it doesn't work they can always try standard therapy," he says. "They've literally got nothing to lose, and a lot to gain." ---Melissa Meyers Gotthardt

"A USER'S GUIDE TO SAW PALMETTO"

If you find yourself suffering from milder symptoms of prostate enlargmment--getting up several times a night to pee, for example, or having trouble making it to the rest- room once the urge hits--and you're considering trying saw palmetto, here are a few things to keep in mind.

"See your doctor", Andrew Weil, M.D., head of the Intergrative Medicine program at the University of Arizona, cautions that saw palmetto should be taken only under a doctor's guidance, after receiving a definite diagnosis of BPH. If you want to go the herbal route and your doctor vetoes the idea, Dr. Weil advises, "Be persistent. If he says, 'Oh, it's an herb, it could be dangerous,' he's probably uninformed about saw palmetto's potential. Be reasonable; let him know you've done your homework and you want to try it, at least for a while. If he still refuses, you may need to seek out a doctor with a more open mind, or more knowledge of herbal medicine."

"Meet the standard". Although the FDA outlawed over-the- counter treatments for BPH back in 1990, saw palmetto is classified as a food plant, so it can be sold legally as a food supplement. Opt for a standardized extract preparation, which means that the capsules contain a guaranteed standard amount of the active ingredient. Several U.S. herbal companies sell standardized saw palmetto extracts. Look for "Herbal Choice" or "Botalia Gold" at Payless and Thrifty stores; or "Solaray Pharmaceuticals" at drug and food stores. To find Solaray products near you, call 1-800-669- 3009. You can also order standardized saw palmetto extract gelcaps from Nutrition Warehouse, 1-800-645-2929. They carry several brands, ranging in price from $19.16 for 60 160-milligram capsules to $19.95 for 100 160-milligram capsules.

"Pass on the berries". If you see powdered or whole saw palmetto berries, pass them by, since you can't be sure how many you'd have to eat to get any results. And while many people swear by saw palmetto tea, drinking it won't do your prostate a bit of good, because the berries' active agents don't dissolve in water.

"Don't overdo". More is not better when it comes to saw palmetto. Dr. Weil has had success with a recommended dosage of 160 milligrams of standardized saw palmetto extract, taken twice a day. And he notes that it can take several weeks of treatment for BPH symptoms to improve. M.M.G.

Part IV

A Testimonial from one of our own:

>Date: Sun, 21 Jul 1996 09:00:36 -0700
>From: Charles Brashear <brashear@MAIL.SDSU.EDU>
>Subject: Saw Palmetto: an anecdotal endorsement, of sorts

Hi all,

I started taking Saw Palmetto on 1 Jul 96, and I got dramatic results. I doubled the dosage in the first two weeks, the way a snake-oil newspaper advertisement recommended.

After 10 days, my dribbles were noticeably improved, as measured by the absence of those pesky yellow spots in my shorts.

After 14 days, I slept through the night, and have slept through 5 of the last 7 nights.

I don't have a double-blind, placebo study on this, but I think my sex-life is even improved. That is a purely subjective perception.

Wow! The Saw Palmetto may not be doing my PCa any good, but it sure makes a difference in my uri-probs.

Mailing List: Prostate Problems Discussion
From: Stephen Strum MD <73140.3041@COMPUSERVE.COM>
Date: Thu, 13 Jun 1996 00:41:07 EDT

>Dr. Braeckman has apparently found that whereas administration of
>Serenoa repens extract does not modify serum PSA concentration, a
>significant decrease in PSA levels occurs with the administration of
>finasteride. It is suggested that this effect by finasteride may mask the
>development of prostate cancer during treatment. It sounds as if the
>study on which this claim is based may be worth a review by one of our
>medical experts.

This issue of masking has been discussed before. A drop in the PSA of significant degree and of durable nature is by far related to an anti-tumor effect. To call this masking is like saying that insulin masks an elevated blood sugar. The paper on Proscar on our homepage discusses med literature citing active anti-PC effect of Proscar. I would not call this masking anymore than I would call Flutamide, Lupron or other drugs as masking. The following is from our paper on Serenoa and Proscar on our homepage. I believe I will have to update it.

Treatment options for men with benign prostatic hypertrophy have included transurethral resection of the prostate (TURP), total prostatectomy, alpha blocker therapy, microwave hyperthermia and transurethral laser incision of the prostate (TULIP). Recently, management of such patients with finasteride, a 5 alpha reductase inhibitor, suggests that at least 30% of men with BPH will significantly benefit from this treatment. 5 alpha reductase (5-AR) is an enzyme involved in the conversion of Testosterone (T) to Dihydrotestosterone (DHT). DHT is believed to be the hormone responsible for stimulating prostatic growth in the central zone of the prostate causing symptoms of slow urination, nocturia, dribbling after urination and increased residual volume. Finasteride (Proscar) reduced serum DHT levels by more than 60% and resulted in a median reduction in prostatic volume of 19% after a 12 month period in a placebo-controlled study involving 895 patients (297 patients received Proscar). Proscar also reduced PSA levels by nearly 50% in these studies. The net decrease in the obstructive symptom score in the Proscar treated group was only 0.8 point. Maximal urinary-flow rate however increased by an average of 1.6 ml/sec with 30% of men reaching 3 ml/sec after 12 months of treatment.(This is compared with a 7 ml/sec increase routinely achieved by TURP). Interestingly, 17% of the placebo group also increased maximal urinary flow by 3ml/sec. The results of Proscar treatment after 2 years indicates a median prostatic volume reduction by 25%, and a maximal urinary flow increase by a mean of 2.3 ml/sec; 50% had an increase of 3 ml/sec or more. Mean symptom score also improved by 3.3 points after 2 years of Proscar therapy. Proscar had no apparent effect on residual urine volume.

A lipid-soluble extract of the Saw Palmetto plant, Serenoa repens, has been in evaluated in at least 9 clinical trials of BPH. Serenoa repens is said to have 3 & 5 alpha reductase inhibitor activity in addition to having androgen receptor blockade activity. Most of these studies were performed between 1983-85 and were either placebo-controlled or open studies. The standard dose of extract was 160 mg twice a day in a preparation called Permixon. In the study of Champault et al. after one month of therapy with 160 mg bid of Permixon, nocturia was decreased in the Permixon arm by 45.8% compared to 15% in the placebo arm (p <0.001). Flow rate increased by 50.5% compared to 5.0% with placebo and residual urine volume declined in the Permixon arm by 41.9% compared to +9.3% in the placebo arm. Significant differences in patient self-rating and physician rating were seen with the use of Serenoa. In 5 other double blind, placebo-controlled studies involving from 22 patients to 110 patients, significant differences were found in the categories of urine flow measurements, nocturia and residual volume. No measurements of prostatic volume, DHT or PSA were done in this or any of the other studies. A recent publication by Merck laboratories has shown no effect of Permixon on serum DHT in 32 men randomized to either Permixon, Placebo or Proscar. Appropriate doses of all drugs were used. Proscar reduced serum DHT to 60% of baseline within 24 hours of initiation of treatment.

Mailing List: Prostate Problems Discussion
Date: Tue, 4 Jun 1996 01:18:47 -0400
From: BurtU@AOL.COM

A paper kindly provided to me by Ralph entitled "Testosterone Metabolism in Primary Cultures of Human Prostate Epithelial Cells and Fibroblasts" by S. Delos of the Experimental Cancerology Laboratory in France, (and 4 other authors) published in the J. Steroid Biochem Molec Biol, Vol. 55, No. 3/4, PP 375-383, 1995, includes interesting info on a comparison of three drugs, finasteride (Proscar), 4-MA, and Serenoa repens (saw palmetto). To my best understanding of the paper, a study was made of testosterone (T) metabolism in primary cultures of epithelial cells (covering surfaces of cellular tissue) and fibroblasts (connective cell tissue) that had been separated from both BPH and prostate cancer cells. In all of the cultures, eighty percent of the resulting metabolites formed consisted of androstenedione (*4) [a slightly modified form of T ] formed by oxidation of T by a process called 17*-hydroxsteroid dehydrogenase (17*-HSD). The remaining metabolites consisted largely of 5*-dihydrotestosterone (DHT) which was formed by reduction of T by 5*-reductase (5*-R).

All three "drugs" tested, 4-MA, finasteride (Proscar), and Serenoa repens (saw palmetto), inhibited DHT formation. However, only saw palmetto inhibited *4 formation as well. [*4 is important because by reduction of *4 by 5*-R and subsequent oxidation by 17*-HSD, DHT is also formed. DHT is the ultimate bi-product of T that interacts with the appropriate receptors to result in tissue growth.]

The authors conclude that saw palmetto differs from the other two inhibitors in that it effectively inhibited both *4 and DHT formation for both the fibroblasts and epithelial cells, suggesting that saw palmetto is an inhibitor of both 5*-R reduction activity and 17*-HSD oxidation activity. Their final statement was: "These results have important theraputic implications when selecting appropriate treatments for BPH". The authors make no statement relative to use of saw palmetto instead of Proscar in treatment of PC, but examination of their experimental data shows that saw palmetto was more effective than finasteride (or 4-MA) for both the BPH and prostate cancer tissue studies.

Note: In transferring this communication from Microsoft Word to AOL, three different Greek letters wer transformed into *'s. The stars should be read as follows: "*4" = "delta" 4; "5*-R" = 5 "alpha" -R; and "17*-HSD" = 17 "beta" -HSD.

Burt Udelson of Manassas, VA <BURTU@AOL.COM>

Newsgroup: sci.med.prostate.prostatitis
From: Myron Walters (mwalters@tmn.com)
Date: 23 May 1996 06:44:54 -0400

I've been using saw palmetto for about 5 years now. It doesn't remove my symptoms entirely, but it does reduce them. It has eliminated the pain upon ejaculation, and reduced the degree of urgency I feel. That's enough for me to swear by the stuff.

I have experimented with both standardized extracts and the berries themselves. I found the standardized extracts to give me more relief. I have also experimented with combinations with pygeum africanis, but didn't notice a substantial difference.

Mailing List: Prostate Problems Discussion
From: "Edward H. Piepmeier" <piepmeie@CCMAIL.ORST.EDU>
Date: Tue, 5 Mar 1996 09:33:09 PST

There is a conflict in your posting that I would really like to understand because it may help us understand more about what is going on in our bodies.

You first state "1. Research has found it [Saw Palmetto] causes *no* PSA fluctuations"

Then "2. Research also shows Saw Palmetto to be the equal of finasteride in slowing the production of DHT. Both are 5-alpha reductase inhibitors. The enzyme 5-alpha reductase is a key to the conversion of testosterone to dihydrotestosterone (DHT, the androgen feeding the prostate, and PCa tumors. However, research also points to SP as blocking the receptors for DHT, and that this may be its most powerful contribution to relief of BPH symptoms."

The conflict is this. If SP slows production of DHT and blocks receptors for DHT, then it should cause cells that depend upon DHT to die. Since these cells produce PSA, the PSA level should drop. (This is the reason that PSA can be used to monitor PCa.) This is inconsistent with the first statement that SP causes no PSA fluctuations.

(Maybe it is inconsistencies that make some physicians wonder about the usefulness of SP.)

Have I misunderstood something here?

If we can straighten out these inconsistencies, then maybe we can learn more about the extent to which SP helps.

Ed
in the Heart of the Willamette Valley

Mailing List: Prostate Problems Discussion
Date: Wed, 6 Mar 1996 09:11:01 -0500
From: RickLWard@AOL.COM

Replying to the Tue, 5 Mar 1996 09:33:09 PST post of Edward H. Piepmeier:

>There is a conflict in your posting that I would really like to
>understand because it may help us understand more about what is going on in
>our bodies.

<SNIP>

>The conflict is this. If SP slows production of DHT and blocks receptors
>for DHT, then it should cause cells that depend upon DHT to die. Since these
>cells produce PSA, the PSA level should drop. (This is the reason that PSA
>can be used to monitor PCa.) This is inconsistent with the first statement
>that SP causes no PSA fluctuations.

<SNIP>

>Have I misunderstood something here?

Yes, and no. I could have been more clear and explicated what is meant by the statement that "1. Research has found it [Saw Palmetto] causes *no* PSA fluctuations". It *is* confusing.

But consider: What is being said is that SP does not, *of itself*, and just by the taking, have *any* impact on PSA. That it might aid in reducing gland size and in that way impact on the expression of PSA by those cells so inclined does not refute or conflict with a statement of *no intrinsic impact on PSA* in my mind.

CHT (Lupron/Zoladex and Eulexin/Casodex), on the other hand, will swiftly bring one's PSA down to less than 1.0 in nearly every case, yet PSA will then just as swiftly return to values at or near pre-treatment levels. This is truly impact that masks what we try to track with PSA tests.

Incidentally, just to clarify, when I made the statement that research equated SP with finasteride in slowing DHT production, I was incorrect; research generally claims SP to be superior. While SP is weaker as an inhibitor of 5-alpha reductase, it has a greater ability to inhibit receptors of DHT, thus ultimately making it superior to finasteride in blocking DHT.

Rick Ward in Deer Lodge, MT

Mailing List: Prostate Problems Discussion
From: RickLWard@AOL.COM
Date: Tue, 5 Mar 1996 02:07:41 -0500

I've been following this subject over the past several DIGESTS, noting many confusions. Having just returned from a couple of months of nearly daily visits to a fine medical library while awaiting my brachytherapy, I searched Medline and the Internet at large, as well as perused the stacks for information on this subject. Most research on serenoa repens has been done in Europe. Seems our domestic medical commuity disdains taking such common and folklor-ish things seriously. Here are a few of the things I found:

1. Research has found it causes *no* PSA fluctuations, unlike finasteride (Proscar) and flutamide (Eulexin). Of course, many domestic uros still tell us just the opposite, probably because they take the position that then only good articles on research are *American* articles—many still sneer at "that Canadian" research on hormonal blockage that includes an androgen blocker.

2. Research also shows Saw Palmetto to be the equal of finasteride in slowing the production of DHT. Both are 5-alpha reductase inhibitors. The enzyme 5-alpha reductase is a key to the conversion of testosterone to dihydrotestosterone (DHT, the androgen feeding the prostate, and PCa tumors. However, research also points to SP as blocking the receptors for DHT, and that this may be its most powerful contribution to relief of BPH symptoms.

3. Side effect in all research are reported to be nil, at doses of 160 mg of 85%-95% berry extract twice a day (320 mg daily). Finasteride continues to be associated with side effect such as reduced libido.

4. Research varies on how quickly SP becomes active for BPH symptom relief: 30 - 60 days being the usual range. Finasteride, on the other hand can take up to a year (PDR says it generally takes effect around 6 months).

When we talk about Combined Hormonal Blockade, or Total Androgen Deprivation, we generally refer to the Lupron or Zoladex shot to effect reversable chemical orchiectomy to remove 95% of the serum testosterone plus Eulexin or Casodex to block the androgen DHT from being utilized by the prostate or the PCa tumor, since even with most of the testosterone production interdicted, DHT level in the gland still appears to be 45% of the pre-Lupron/Zoladex introduction.

Now if 5-alpha reductase is critical to the conversion of T to DHT, then any inhibitor of 5-alpha reductase would logically impair that process. It is becoming an increasingly common practice to include finasteride (Proscar) in long term CHB for this very effect.

Saw palmetto can serve the same purpose, quicker and without side effects, and appears to also interfere with the DHT receptors in the gland.

NCI is apparently beginning studies on the mechanism of saw palmetto, so perhaps in 5 years or so we will find greater acceptance by the U. S. medical community. It is commonly used by the European medical community for BPH control now.

Rick Ward in snowy Deer Lodge, Mt

Mailing List: Prostate Problems Discussion
From: HiMarkham@AOL.COM
Date: Mon, 4 Mar 1996 08:55:51 -0500

>Saw palmetto has no known effect on prostate cancer. In fact, we don't
>know if it reduces prostate size or makes the detrussor (the bladder
>muscle) work more effectively, or if it merely relaxes the smooth muscle
>cells in the prostate and bladder neck (like Hytrin). If your grandfather
>had prostate cancer, you should think about a yearly digital rectal exam
>and PSA starting at the age of 40.

>RobertL567 (urologist)

>Saw the following post several months back. It seems like it will add some
>additional food for thought:

>Lynda said:
>Because of my work on the Prostate Cancer Prevention Trial, I have an
>interest in Saw Palmetto. I called the dispensary at Bastyr Naturopathy
>Institute (an institution with enough research credit to be awarded
>one of NIH's alternative medicine research grants) and they said that
>Saw Palmetto works in the same way as finasteride (Proscar), i.e., it
>is a 5-alpha reductase inhibitor. That means it prevents testosterone
>from being converted into Dihydrotestosterone (DHT) in the prostate.

>DHT is thought to have a part to play in both benign hyperplasia and
>prostate cancer, which is point of our trial. We are trying Proscar
>in a large randomized clinical trial in hopes that it prevents prostate
>cancer. So, perhaps Olivier was more concerned with prevention
>of disease than existing disease.

>Whether Saw Palmetto really is a 5-alpha reductase inhibitor is not
>clear. I was told that it "works like Proscar, but DOESN'T reduce
>the PSA to the same extent". I think we have some references from
>European journals (almost nothing is found on Medline). I'll post
>them if I can find them.
> Lynda Emel, Ph.D.

>If it does indeed have an effect on the DHT conversion process, it would seem
>to be something worthwhile to study.

>Mike (4 year survivor).

Hi Mike,

I just did a search on Medline and found a few european studies on saw palmetto dating back to 1984. They are all under the botanical nameSerenoa repens. Here are some excerpts of a few citations

1. After 12 h, a single dose of finasteride 5 mg reduced the serum dihydrotestosterone level by 65% (p < or = 0.01). The decreases ranged from -52 to -60% with multiple doses of finasteride 5 mg once a day (p < or = 0.01). As in the placebo group, there was no effect of Permixon on the serum dihydrotestosterone level. No significant difference was detected between finasteride and Permixon or between finasteride and placebo with respect to serum testosterone, except on days 3 and 6, respectively (p < or = 0.05). However, the corresponding serum testosterone levels remained within the normal ranges. These data confirm the efficacy of finasteride as inhibitor of 5 alpha-reductase.

2. Permixon, the liposterolic extract of the plant Serenoa Repens is a recently introduced drug for the treatment of benign prostatic hyperplasia. The effect of Permixon on dihydrotestosterone and testosterone binding by eleven different tissue specimens was tested. The drug reduced the mean uptake of both hormones by 40.9% and 41.9% respectively in all tissue specimens.

3. Permixon, a liposterolic extract of the plant, Serenoa Repens B, inhibits competitively the binding to the cytosolic receptor of the rat prostate. Various vegetable and mineral oils, the plant steroid: beta sitosterol and the antiprostatic drug: Tadenan, were all found to be inactive. The antiprostatic activity of Permixon shown in animal studies and controlled clinical trials, may thus result from a direct action at the cytosolic receptor.

The present studies show that S.R.E. (Serenoa Repens extract) inhibits 5 alpha-reductase, 3-ketosteroid reductase and receptor binding of androgens in cultured human foreskin fibroblasts. As the search for the ideal antiandrogen continues, S.R.E. appears to be a new type of antiandrogenic compound as therapeutics for the treatment of benign prostatic hypertrophy, hirsutism and so forth.

Newsgroup: sci.med.prostate.bph
From: David Mendosa <mendosa@cruzio.com>
Date: 2 Feb 1966 7:31 PM

If you are taking saw palmetto extract or planning to do so, I'd suggest that you stock up now—if it isn't already too late. Saw palmetto extract is going WAY up in price.

A few days ago a clerk at a store that sells it told me they just raised the price. But even worse is probably coming.

"The available supply [will] be the smallest in recent memory," according to an article "Behind the Rise in Saw Palmetto Prices" in the January 1996 issue of Whole Foods magazine. "Driving rain and fierce winds ripped berries from the plants."

The article quotes James Selander, the president of Solaray Inc., which I know as one of the highest quality manufacturers of saw palmetto extract. Selander says that as of September, when most of the collection was completed, there were 600,000 pounds on hand, while in previous years several million pounds were processed. Most of this, of course, goes to Europe.

Selander says that in late summer he personnally had let a team through the area of Florida where saw palmetto grows to see the damage first hand. He says he found that collectors were getting $3 to $3.25/pound for berries, compared to about 20 cents in normal years. Most if not all of the crop grows wild and is harvested by collectors.

He and Hans Lingren, director of operations for NBTY, the parent company of American Health and Nature's Bounty, says that as of November the retail price was holding steady but that "this was on older merchandise only, and they expected significant rises by January."

Grace Lyn Rich, marketing directory for Nature's Herbs, said that "stores would be paying about double what they did a year ago, and that the same rate of increase would apply for consumers."

Demand is also going way up, the article says. The reduced supply comes at the same time as "increasing numbers of companies are beginning to make structure/function claims for the herb. Such claims, authorized by the Dietary Supplement Health and Eduation Act of 1994, are expected to boost demand for this and other products."

I still don't know the best source of saw palmetto extract. The least expensive one that I have been able to find is from the Life Extension Foundation in Florida. They sell 60 capsules of what they call Serenx, their saw palmetto berry extract, 160mg standardized to a minimum of 85% total fatty acid content, for $15.

But I don't know if they use the supposedly toxic hexane extraction or the much more expensive supercritical fluid extraction procedure that companies like Solaray use. And I am not really comfortable with the Life Extension Foundation's rather far-out reputation.

Anyway, prompted by knowledge that the price of saw palmetto extract is going up I just ordered enough to last me for six months from them.

Newsgroup: sci.med.prostate.bph
From: bobw@netzone.com (Bob Werner)
Date: 17 Jan 1966 10:36 PM

In article <4deppj$qhd@rigel.pixi.com> repstein@pixi.com writes:

>I'm no expert, but I read a lot of scientific/medical journals: 600 mg, 2-3 capsules at
>3 times/day is higher than any other study I've seen for a "normal" (non-
>experimental) dose. I'd suggest reducing that by a big margin, unless a
>knowledgeable physician is constantly monitoring you at that high dosage.

>One problem I've seen is that some herb companies do not have good quality
>control. It's very important the effectiveness of the dose does not vary from "bottle
>to bottle." As herbs (saw palmetto and others) are harvested during different times
>of the year, their potency varies. Also, the age, location, rainfall, amount of sun,
>etc. all impact the plant's potency too. So the dose that's recommended by a
>particular company could be trying to compensate for variable, or substandard,
>potency; who knows? I generally dislike the FDA, but someone has to monitor the
>claims and quality of companies selling (herbal) medicines. Pick a brand that has the
>best quality and assurance of consistent potency. Good luck!

Are we talking about the same thing....There are to my knowledge at least three types of Saw Palmetto on the market. There is labeled type 1) Saw Palmetto 2) Saw Palmetto Berries and 3) Saw Palmetto Extract.

I think there is confusion here because there can be different recommended (on the bottle) dosages. What I have seen is that 1) and 2) require larger dosages like 400-600 mg size capsules and a recommended dose of 2-3 following each meal. Number 3) being the extract and supposedly purer recommends just 1 or 2 140 = 160 mg per day. There is a price difference here also, the extract being the most expensive per pill.

I'm no expert on this subject and neither is my urologist.....but he said if it helps, take it. I have opted after approximately 4 months to go with the extract full time when the others are used up. It sure is helping along with 4 mg of Hytrin per day..

Newsgroup: sci.med.prostate.bph
From: repstein@pixi.com
Date: Mon, 15 Jan 1996 04:48:34 GMT

To Lynda and Other Respondents,

I've gotten many replies to this original posting, and I'm quite appreciative. What I've discovered to date is:

1.) There are few, if any, published or known side effects of saw palmetto berry extract.

2.) At dosages of 320mg/day (160mg after lunch and after dinner) I do get an ache in the prostate region and--I recently discovered--so does my father. He switched to liquid-form saw palmetto extract and reduced the dose to approximately 100 mg (after dinner) and gets benefits, with no side effects. This lower dose is what I'll try next.

3.) When I met with my MD yesterday, he was unaware (and understandably suspicious) of saw palmetto, but is willing to let me share with him the few MEDLINE medical journal articles on the subject. More reseacrh is needed here, and also for Pygeum, a similar remedy, since they appear to have less severe adverse reactions rhan prescription drugs.

Again, thanks to you all for the feedback and I'll post any new significant findings as I learn them.

--Bob

Newsgroup: sci.med.prostate.prostatitis
From: tamarantha@aol.com (Tamarantha)
Date: 30 Dec 1995 12:48:31 -0500

PROSTATE PROBLEMS
Are There Healthy Alternatives?
By Tamarantha@aol.com

We all have husbands, lovers, significant others, fathers and brothers. As we all get older, each sex has it's own problems to contend with. Unfortunately for the men in our lives, prostate problems can begin as early as age 40. This past year my husband, Randy, turned 40, and prostatitis "magickally" and suddenly appeared. For us it has been a life altering struggle, which is one of the many reasons I am writing this article. If we can prevent someone else from going through what my husband has gone through, being truthful will be more than worth it to us.

Any man who has a desk job and drinks copious amounts of caffeine is highly prone to develop a prostate infection. Unfortunately most family doctors don't have a clue as to what it takes to overcome a prostate infection. It took six months for our family physician to send Randy to a urologist, by then he was in pretty bad shape. It has been almost two years since Randy's first symptoms, and we are still fighting tooth and nail to get him well.

Prostatitis, or inflammation of the prostate gland, can be caused by a bacterial infection or a virus. It can also be transmitted sexaully, yet can just as easily develop out of a simple irritation or activity such as bicycle riding. It can also be aggravated by inactivity. Prostatitis is usually very painful. In some instances there is a pressing sensation, feeling a desperate need to urinate, with burning pain during urination. Sometimes pain can radiate into the lower back, scrotom and rectum. In severe cases, the infection can move through the bladder and into the kidneys, although this is relatively rare. Often there is pus or blood in the urine, and fever is sometimes present. If you know of anyone having these symtoms, demand that your family doctor refer him to a urologist immediately. If caught early, a treatment of anitbiotics can sometimes clear this up completely, but it will more than likely take a urologist and his expertise to get the best results. The prostate "lives" in its own private little world, and the medications need to be specifically geared for the prostate. The usual ten day round of antibiotics will not be effective.

If the prostatitis becomes chronic, most physicians will prescribe Hytrin or Proscar. Hytrin is usually used to control high blood pressure, but will also boost urine flow. Hytrin works as a smooth muscle relaxant, and from what I understand simply masks the symptoms rather than cure them. Proscar works the same way, yet has many debilitating side effects. These side effects include decreased libido, impotence and ejaculatory disorders. Proscar is also HIGHLY toxic to the male fetus. The insert that comes with the drug contains a warning that reads:

"Exposure of Women-Risk to Male Fetus

"It is not known whether the amount of finasteride (Proscar) that could potentially be absorbed by a pregnant woman through direct contact with crushed Proscar tablets or from the semen of a patient taking Proscar can adversely affect a developing fetus....Therefore, because of the potential risk to a male fetus, a woman who is pregnant or who may become pregnant should not handle crushed Proscar tablets; In addition, when the patient's sexual partner is or may become pregnant, the patient should either avoid exposure of his partner to his semen or he should discontinue taking Proscar."

According to the 1995 Physicians Desk Reference, Proscar is highly toxic and does cause birth defects in the male fetus. Neither drug had much appeal to us as we didn't see any benefits in taking medications that only mask symptoms, yet can be so toxic and have such terrible side effects.

If the above mentioned drugs don't bring results the other options aren't much better. Tranurethral resection, or TURP, is another procedure that is common today. During this process, tissue slicing instruments are inserted into the urethra to reach the prostate. Once there, they scrape away enlarged portions of the prostate. After this procedure, there tends to be bleeding, seepage and quite often post-operative infection. Some possible side effects are incontinence in two to five percent of the patients and permanent impotence in five percent. Imagine living the rest of your life if your not one of the lucky 95%.

There is however, a new medical therapy that is being used at the Mayo Clinic and various other medical institutions around the country, and the world. This new therapy is hyperthermia. Developed in Israel in the 1980's, it's based upon the principle that it is possible to heat and destroy the enlarged tissue within the prostate without disturbing the function of the gland. There are two other promising treatments, cryosurgery and laser surgery. These other procedures sound promising and may come to be a big improvement over the TURP, but are still regarded as experimental at this stage.

There are several studies available that show patients have had better, safer results with more natural remedies. These studies show that saw palmetto increases urine flow by 38%, as compared to a 16% increase with Proscar or Hyrtin. The following are the suggested herbal/mineral supplements to begin taking around age 40 to help prevent prostate problems:

80mg. Saw Palmetto (The lipid extract) twice a day
30mg. Zinc Picolinate
25mg. Manganese
Omega 3 and Omega 6 Fatty acids (Flax Oil) 2 tbsp. twice a day
1-2 grams Amino Acids (L-glutamic, L-alanine, L-glycine)
Daily High Potency vitamin and mineral supplements that include antioxidants

If you already have prostate problems, or develop symptoms the saw palmetto can be increased to 160-320mb., the zinc picolinate to 60mg., all other supplements remain the same.

The flax oil needs to be fresh and unheated.

References:

The Prostate Report; Julian Whitaker, MD
Healthy Revelations Robert C Atkins, MD (May '93)
Second Opinion Dr. William Campbell Douglass (9/93)
Health & Healing Julian Whitaker, MD (9/93)
1995 Physicians Desk Reference

Newsgroup: sci.med.prostate.bph
From: bking@xmission.com (Bill King)
Date: 26 Dec 1995 17:50:41 GMT

I had something impressive happen to me last week. I have had problems with allergies and congestion for years. I have routinely taken antihistamines and decongestants for years, with no noticeable effect on my frequency of urination or trips to the bathroom at night. (BTW, I have BPH and have had for some time.)

A couple of months ago I started taking Saw Palmetto (2 capsules 3 times a day, various brands) and noticed a great improvement. Since the improvement has been slow, the extent of it has not really been noticeable. Coincidentally, during this period I have not had any problems with allergies or congestion, so have not taken an of the no-no meds.

Last week we in Salt Lake City got the first of our ungodly (and frequent) temperature inversions, which means serious gunk in the air, severe smog and respiratory problems for all. When this happens each year, I get (you guessed it) congested. In the past I have found relief by taking various decongestants and sometimes antihistamines, all warning not to take if you have BPH.

All of a sudden I have to take a long novel with me each time I go to the bathroom, endure a split stream and prolonged dribble. Up and down 3, 4, 5 times a night (I lose track.) My wife, who practices medicine points out the connection. I say yeah, but I've been doing this for years and never noticed it to get worse with decongestants. She says but—you've been taking Saw Palmetto!

Duh! I got so much better on the Saw Palmetto that I finally noticed that decongestants do make BPH symptoms worse! I dropped everything with the package warning, but it took about a week before my flow, frequency and times up at night returned to the good place they had been.

I am a professional doubter, but Saw Palmetto does the job for me. The only problem is that I need t he decongestants so much that I may have to opt for surgery. I guess I'll wait and see.

Mailing List: Prostate Problems Discussion
From: Don Straw <nagor@COUGAR.MULTILINE.COM.AU>
Date: Tue, 19 Dec 1995 15:21:34 +0800

There is a booklet written by Dr. Michael Murray, N.D. called "The Saw Palmetto Story" (US$2.95). Dr. Murray is president of Vital Communications and the address is 15401 S.E. 54th Ct., Bellevue, WA 98006. 1-800-488-0753.

Mailing List: Prostate Problems Discussion
From: Ralph Valle <ralphv@NETZONE.COM>
Date: Sat, 14 Oct 1995 11:49:00 -0700

>Many comments have made in this list and in printed publications about the possible
>benefits of saw palmetto for treatment of BPH. Some have posted success stories
>and others not much luck in reduction in size of the gland.
>
>I have not located much if any info on the effect of saw palmetto on PSA testing.
>According to Merck & Co. the drug Proscar lowers PSA readings even in the
>presence of PCa and requires approx. 9 mos before readings are stable at a approx.
>50% reduction rate, i.e. take the new PSA level and double it to get the comparative
>reading to pre Proscar administration. Since it is believed that saw palmetto works
>like Proscar by reduction of DHT. Does saw palmetto also adversely effect PSA
>readings?

The reduction of DTH caused by Proscar is induced by inhibiting the enzyme 5Alpha-reductase. The lower PSA is a true result and the reason Merck says what it says is because they market the drug for BPH and not PCa. As you probably know there is a very large trial to verify if Proscar can prevent PCa. The results won't be known for many years. Saw Palmetto also claims to have the same effect on DTH. I don't know if that is true or not. I have found very little information and no medical trials reported. Here is a note from Prodigy on Saw Palmetto:

Board: MEDICAL SUPPORT BB
Topic: CANCER
Subject: PROSTATE CANCER

To: ALL Date: 09/21
From: CPTW48A JIMMIE MITCHELL Time: 5:36 PM

From: Prevention, Aug. 95

"...if common BPH is found, there is surgery, the relatively new drug finasteride, or in less serious cases, learning to live with it.

But there is another alternative these days—an herbal formulation made from a plant called saw palmetto. Growing wild in the American southeast, and long used as a folk remedy here, its now cultivated and the berries shipped to Europe.

There, the berries are processed by pharmaceutical firms into a standardized product with guaranteed potency.

European men take it in droves. Many doctors there prescribe it. The German Commission E, which evaluates natural therapeutic agents, has given its blessing to saw palmetto. The United States has nothing comparable to Germany's Commission E. As far as our Food and Drug Administration is concerned, the lack of American research with the herb makes it ineligible for any kind of approval.

In Europe, though, there's been lots of research, much of it carried out in a very careful manner.

One of the earliest studies, by a French group, looked at the effect of saw-palmetto extract on 94 men with the usual BPH symptoms. Actually, only half got the herb; the others received a look-alike placebo to rule out the power of suggestion.

After a month, the doctors interviewed and evaluated the men, without being aware of what group they were in - the herb or placebo. What they found was that the herb takers reduced the number of times they had to get up at night by nearly half, increased their flow rate by the same amount, and lessened residual urine by 42 percent. The placebo group fared much worse; their residue, for instance, actually increased by 9 percent (British Journal of Clinical Pharmacology, volume 18, 1984).

An Italian study published in Urologia in 1988 found much the same. With saw palmetto (which they refer to by its Latin name, Serenoa repens), nighttime bathroom visits decreased from an average of just over 4 per night to about 1.5 after three months. The placebo group saw no improvement.

Prevention herbal advisor, Varro Tyler, Ph.D., reports that good studies on 2,000 BPH patients in Germany confirm the effectiveness of saw palmetto extract.

If you're wondering how a berry can be so good for the prostate, scientists have a pretty good idea of how it works.

What triggers prostate growth is a ..... form of the male hormone testosterone. Its called DHT (for dihydrotestosterone), and when it gets to an older man's prostate cells, it makes them think they're going through puberty again, and the gland begins packing on the beef.

As for where this troublemaker comes from—well, from an instigator enzyme called 5 alpha reductase, which causes normal testosterone to switch into the hopped-up DHT.

Saw palmetto seems literally designed to tackle this mess because what it does is:

1. Deactivate the enzyme (5 alpha reductase)

2. Prevent DHT from acting on prostate cells, and

3. Serve as a mild anti-inflammatory on the troubled prostate gland.

The basic mechanism here turns out to be the same as in the prescription drug finasteride....Side effects? Reports we've seen say they are rare and nonspecific. Still, if and when you use herbs of any kind, be cautious and watch for unexpected reactions.

Can you make a tea from saw palmetto? No, it won't do anything for your prostate because the active ingredients are not soluble in water. All the research we've seen was done with standardized extracts made in Europe (now sold here, too), with a daily dose of 320 milligrams a day (two 80 mg. capsules, twice daily).

Keep in mind that saw palmetto is not approved by the FDA for any use in the United States. Anyone taking it should check with his physician."

Mailing List: Prostate Problems Discussion
From: John Boik <JohnBoik@AOL.COM>
Date: Sun, 1 Oct 1995 20:49:52 -0400

Here is an excert on saw palmetto from my new book Cancer and Natural Medicine: A Textbook of Basic Science and Clinical Research:

"Serenoa repens (saw palmetto) is used in Western herbology to treat benign prostatic hypertrophy (BPH). In 20 men with BPH, administration of the lipid extract for 30 days did not affect plasma testosterone levels. Rather, serenoa appears to inhibit the metabolism of testosterone (by the enzyme 5 alpha-reductase) to its more potent form, dihydrotestosterone, and appears to block the binding of testosterone to tissues by competing for binding sites.

Lipid extracts of serenoa inhibited 5 alpha-reductase activity and effectively blocked testosterone receptor binding in human fibroblasts in vitro. The lipid extract inhibited the binding of testosterone by 42% and dihydro-testosterone by 41% in 11 different tissue specimens. In contrast to these studies, other investigators reported that lipid extract did not exhibit 5 alpha reductase inhibitory activity in vitro. (Casarosa et al., 1988; Sultan et al., 1984; Delos et al., 1994; El-Sheikh et al., 1988; Carilla et al., 1984; Rhodes et al., 1993)"

Mailing List: Prostate Problems Discussion
From: "Michelle M. Davis" <mdavis@PINEGOV.CO.PINELLAS.FL.US>
Date: Wed, 30 Aug 1995 08:23:06 +0100

Information taken from Today's Herbal Health by Louise Tenney. I have the 2nd edition published by Woodland Books ISBN 0-89557-069-6

Saw Palmetto (as some have suggested to take w/PCa) is recommended in all wasting diseases because it has an effect upon all the glandular tissues. It is also useful on all diseases of the reproductive glands. Contains Vitamin A.

Mailing List: Prodigy's Medical Support BB, Topic; Cancer
From: DeWitt Ober <dober@worldnet.att.net>
Date: Aug 12, 1995

The following information is taken from text that I have read. This is my attempt to put it altogether in one place for the benefit of others.

Tapio Visakorpi of the National Center for Human Genome Research in Bethesda, Md., and a team of U.S. and Finnish colleagues have discovered that men treated with hormone- blocking therapy had extra copies of a gene known as the androgen receptor gene. On average, tumor cells contained from 4 to 22 androgen receptor genes. In one case, a tumor cell had 40 receptor genes. Healthy prostate cells contain only one such gene, which resides on the X chromosome. The gene copying appears to take place as a result of treatment. When the team looked at prostate tumor samples taken from the same patients prior to therapy, they found no such gene amplification. The findings indicate that some prostate tumors may adapt to, or even thrive in, the environment created by hormone-blocking therapy. In response to the decreased androgen production, tumor cells multiply the androgen receptor gene. Such malignant cells probably crank out lots of the gene's protein product and thus can efficiently make use of even low concentrations of androgen. The findings suggest new treatment avenues for men who have recurrent prostate tumors. At present, doctors give such patients standard doses of hormone-blocking therapy. The new study suggest that doctors should increase the dose, if it can be done safely, thus creating a more effective androgen blockade. The findings may also lead to better treatment for men with newly diagnosed prostate cancer. Doctors might start off with a therapy aimed at complete blockage of androgen. This drastic approach just might stop prostate cancer in its tracks.

Recently there has been a growing advocacy for the addition of a third element, in the attempt to obtain a more complete hormonal blockade (CHB), in the treatment of CaP by combination hormonal therapy (CHT).

1) Prostate cancer is androgen dependent. Specifically, dihydrotestosterone (DHT) is the potent form of androgen which stimulates prostate gland enlargement and prostate tumor growth. Testosterone is only one of the available androgens which is converted to DHT. In men, approximately 40% of the overall androgen supply is synthesized from precursors secreted by the adrenal glands.

2) This conversion of androgens to DHT is accomplished by the enzyme 5-alpha-reductase in the prostate tissue.

3) The prescription drug Proscar, parmaceutical medication for treatment of benign prostatic hyperplasia (BPH) is an inhibitor of 5-alpha-reductase necessary for formation of DHT. Administration of this drug could conceivable have a beneficial result.

4) Recent studies in France showed that an extract of the berries of saw palmetto (serenoa repens) inhibits the production of the enzyme 5-alpha-reductase. The pure form of serenoa repens is called Pro Senoa. Works far better than the (expensive) drug Proscar. Although not clinically proven, the 5-alpha-reductase inhibition of the conversion of the androgens to DHT works in conjunction with CHT. Many patients have added Pro Sanoa as augmentable treatment with no adverse effects.

5) Ed Olive recently posted a note to the board that he down loaded from the Internet, 08/04, 2:48 PM. Titled: "Saw Palmetto Extract VS. Proscar". It contained alot of very good information. Read it!!!!!!

From: drweed@delphi.com (Duane Weed, D.C.)
Date: 16 Jun 1995 00:16:22 GMT

I have used myself (I had benign prostatic hyperplasia or BPH) with very good results. Another herb, pygeum, also helped me. My latest free e-mail herb newsletter is on this subject and includes a lot of references. There has been a lot a research on these two herbs for this problem including double-blind studies. Reply private e-mail if you would like for me to send you a copy of my latest newsletter including the references.

Dr. Duane Weed, DC <;* E-Mail request for my FREE Herb>
drweed@delphi.com <;* Guide/Catalog. Include address.>

From: klier@cobra.uni.edu
Date: 15 Jun 95 15:38:54 -0500

A preparation containing the lipophilic components of _Serenoa repens_ fruits is available in Germany for treatment of conditions associated with benign prostatic hyperplasia. It has not been shown to be effective, and is not available for that purpose in the US.

The compound that is presumed to be beneficial is an anti-androgen.

An excellent reference for questions like this is Varro E. Tyler's The Honest Herbal, 3rd ed, 1993, Pharmaceutical Products Press. Dr. Tyler is a pharmacognocist at Purdue; his book is readable, excellent, and has appropriate references to the scientific literature.

Kay Klier klier@cobra.uni.edu

From: sallyd@bga.com (Sally Duncan)
Date: 15 Jun 1995 05:44:38 GMT

From The Herb Book by John Lust:

Saw Palmetto

[Description deleted]

Properties and Uses:

Diuretic, expectorant, tonic. Saw palmetto berries are particularly useful for conditions associated with colds, asthma, and bronchitis. Catarrhal problems and mucous congestion respond to a tea made from the dried berries. The tea has also been recommended as a general tonic to build strength during convalescence from illness. Saw palmetto is considered by some to have aphrodisiac powers.

Last modified: March 28, 2004

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